In this exploratory/developmental application we propose to create a Center for Claims-Based Cancer Research as a consortium between the Mailman School of Public Health at Columbia University and Group Health Incorporated (GHI). New York City-based GHI is the largest statewide not-for-profit health insurance provider. The diverse racial and ethnic makeup of the nearly 3 million GHI subscribers is a reflection of New York City - about 25% African American, 28% Latino, and 10% Asian - making it a valuable resource for studies of cancer disparities. Extensive dependent coverage enables us to study spouses and children. Our long-term goal is to carry out research on cancer screening and interventions, diagnosis, treatment, and outcomes using the large subscriber base as a core resource. Our immediate goal is to create the infrastructure for the center and demonstrate its usefulness by accomplishing three specific aims. Aim 1. Define the scope and structure of the Research Center. An Executive Committee will provide expertise in cancer epidemiology, oncology, surveillance, health services research, and large database technology, guide selection of relevant and feasible research questions, and develop guidelines for collaboration and for human subject protection. Aim 2. We will lay the groundwork for surveillance studies by (Aim 2a): characterizing the GHI subscriber population, describing the distributions of epidemiological and socio-demographic variables including race/ethnicity, employment status, age, gender, and dependency (e.g., spouse, child), (Aim 2b) developing procedures for identifying and assessing cancer screening and diagnostic procedures, and treatments within claims data, and (Aim 2c) determining benefits and effort required for linkage of GHI cancer claims data with external data sources such as tumor registries. Aim 3. We will probe the usefulness for cancer surveillance, health services and outcomes research of the GHI claims database by carrying out three pilot projects: Pilot A. A study of the variation in initial treatment and subsequent chemotherapy for cancers with both high (breast, colon) and low (pancreatic, esophageal) survival times in relation to hospital volume, hospital socioeconomic profile, physician characteristics, and patient socioeconomic status. Pilot B. Estimation of the prevalence of screening examinations for the detection of breast and colon cancer in relation to patient socioeconomic characteristics. Pilot C. Creation of a cohort of incident cases of breast, colon, prostate, and lung cancer, as a research resource for investigating outcomes of different treatment modalities, comorbidity, post-discharge complications, and survival, as well as estimation of treatment costs. [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable]